腹膜透析充分性的评估培训课件.ppt

1、398213114613305010015020025030035040045020012006201120162021PM Population腹膜透析充分性的评估11/5/20221腹膜透析充分性的评估11/5/20222长期长期长期长期PDPDPDPD技术失败的原因技术失败的原因技术失败的原因技术失败的原因腹膜炎腹膜炎透析不充分透析不充分没有妥善处理没有妥善处理/选择选择腹透管腹透管其他其他36%25%20%5%14%腹膜透析充分性的评估11/5/20223腹膜透析充分性的评估11/5/20224腹膜透析充分性的评估11/5/20225腹膜透析充分性的评估11/5/20226腹膜透析充分

2、性的评估11/5/20227腹膜透析充分性的评估11/5/20228腹膜透析充分性的评估11/5/20229腹膜透析充分性的评估11/5/202210Total Kt/V=Kt/VR+Kt/VP24hr尿量尿量尿尿素尿尿素/BUN 每周透析天数每周透析天数体重（体重（Kg）0.6(男男)或或0.55(女女)24hr透析液透析液排出总量排出总量尿素尿素D/P 每周透析天数每周透析天数体重（体重（Kg）0.6(男男)或或0.55(女女)Kt/VR=Kt/VP=Baxter Healthcare Corporation,94腹膜透析充分性的评估11/5/202211Total Ccr=CcrR+Cc

3、rP(尿尿肌肌酐酐/Scr)+(尿尿尿尿素素/BUN)尿尿量量每每周周透透析析天天数数2 CcrP=肌肌酐酐D/P 24hr腹腹透透液液排排出出总总量量每每周周透透析析天天数数 用用体体表表面面积积校校正正：total Ccr1.73m2患患者者体体表表面面积积CcrR=Baxter Healthcare Corporation,94腹膜透析充分性的评估11/5/202212腹膜透析充分性的评估11/5/202213腹膜透析充分性的评估11/5/202214腹膜透析充分性的评估11/5/202215腹膜透析充分性的评估11/5/202216腹膜透析充分性的评估11/5/202217腹膜透析充分

4、性的评估11/5/202218Expected 2-year patient survival according to sustained weekly Kt/V andCcrKt/V survival(%)Ccr survival(%)2.3 81 95 862.17880 811.9 74 70 78 1.7 71 55 721.5 66 40 65Churchill DN JASN,96腹膜透析充分性的评估11/5/202219Relationship between solute clearance and relative risk of death(CANUSA)relative

5、 mortality riskKt/V 0.1/wk 5%Ccr 5L/wk/1.73m2 7%Churchill DN,JASN,96腹膜透析充分性的评估11/5/202220腹膜透析充分性的评估11/5/202221腹膜透析充分性的评估11/5/202222腹膜透析充分性的评估11/5/202223腹膜透析充分性的评估11/5/202224腹膜透析充分性的评估11/5/202225Ademex:Study Design A Randomized Controlled Clinical Trial(RCT)Baseline:965 patients with peritoneal CCr a

6、nd 30g/Lp=0.6801p=0.3007腹膜透析充分性的评估11/5/202232ADEMEX:Different BSAp=0.8010p=0.7788p=0.5628腹膜透析充分性的评估11/5/202233腹膜透析充分性的评估11/5/202234Hong Kong study 321 new CAPD patients with initial renal Kt/V 2.0 Dialysis prescription increased or decreased to meet target Half yearly assessment Mean FU 24.3 monthsL

7、o,KI 2003;64:649-56腹膜透析充分性的评估11/5/202235Hong Kong randomized prospective interventional study group Cgroup Bgroup Ap=0.0000Months31251913710Total Kt/V2.42.32.22.12.01.91.81.71.61.51.4腹膜透析充分性的评估11/5/202236Renal Kt/VMONTH3731251913710Renal Kt/V.7.6.5.4.3.2.10.0group Cgroup Bgroup Ap=n.s.腹膜透析充分性的评估11/5

8、/202237Peritoneal Kt/VMONTH3731251913710peritoneal Kt/V2.42.22.01.81.61.41.2group Cgroup Bgroup Ap=0.0000腹膜透析充分性的评估11/5/202238Hong Kong Study-Clinical survival 4 40 05 50 06 60 07 70 08 80 09 90 01 10 00 00 06 61 12 21 18 82 24 43 30 03 36 6M onths on CAPDCumulative survival,%A AB BC Cp=0.158P=0.054

9、 between group A and B腹膜透析充分性的评估11/5/202239腹膜透析充分性的评估11/5/202240腹膜透析充分性的评估11/5/202241腹膜透析充分性的评估11/5/202242腹膜透析充分性的评估11/5/202243腹膜透析充分性的评估11/5/202244腹膜透析充分性的评估11/5/202245腹膜透析充分性的评估11/5/202246腹膜透析充分性的评估11/5/202247腹膜透析充分性的评估11/5/202248CANUSA study effect of peritoneal transportRisk of deathtechniqueeit

10、her Low transport1.01.01.0 Low average1.603.262.54 High average2.304.043.39 High 1.945.824.0腹膜透析充分性的评估11/5/202249腹膜透析充分性的评估11/5/202250腹膜透析充分性的评估11/5/202251腹膜透析充分性的评估11/5/202252腹膜透析充分性的评估11/5/202253腹膜透析充分性的评估11/5/202254腹膜透析充分性的评估11/5/202255腹膜透析充分性的评估11/5/202256腹膜透析充分性的评估11/5/202257Total fluid removal

11、 and survival in Total fluid removal and survival in incident PD patientsincident PD patientsAtesAtes K,KI 2001(60):767K,KI 2001(60):767-7676IV:2035 ml/dayIII:1570-2053II:1265-1570I:232 mmol/dayIII:181-232II:130-181I:130腹膜透析充分性的评估11/5/202259腹膜透析充分性的评估11/5/202260腹膜透析充分性的评估11/5/202261腹膜透析充分性的评估11/5/20

12、2262腹膜透析充分性的评估11/5/202263腹膜透析充分性的评估11/5/202264腹膜透析充分性的评估11/5/202265腹膜透析充分性的评估11/5/202266腹膜透析充分性的评估11/5/202267腹膜透析充分性的评估11/5/202268腹膜透析充分性的评估11/5/202269腹膜透析充分性的评估11/5/202270腹膜透析充分性的评估11/5/202271腹膜透析充分性的评估11/5/202272腹膜透析充分性的评估11/5/202273腹膜透析充分性的评估11/5/202274 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 0 1

13、0 20 30 40 50 60 70 Time on PD,monthsMortalityAsianCaucasian腹膜透析充分性的评估11/5/202275不不同同人人群群的的体体表表面面积积比比较较BSA*美美国国腹腹透透人人群群：1.85m2上上海海腹腹透透人人群群：1.60m2*Baxter Healthcare Corporation,96Data from RenJi PD Unit,99腹膜透析充分性的评估11/5/202276以以较较小小容容量量进进行行腹腹透透的的上上海海患患者者情情况况Kt/V:1.99/wkCcr:74.9L/wk/1.73m2PV:1.52L/袋袋，610L/dRRF:2.26ml/min2年年患患者者生生存存率率：90%2年年技技术术存存活活率率：76%Data from RenJi PD Unit,99腹膜透析充分性的评估11/5/202277腹膜透析充分性的评估11/5/202278腹膜透析充分性的评估11/5/202279